ADULT NURSING MENTAL HEALTH ALTERATION IN COPING

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ADULT NURSINGMENTAL HEALTH ALTERATION IN
COPING

• Tracy Petleski, MSN, RN

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Substance Abuse
Substance-use disorders Is an umbrella term that
is used to describe substance use and
abuse. Substance abuse Is repeated use of
alcohol or drugs leading to functional problems.
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Substance Use Disorders
Substance Dependency The continued use of
alcohol or drugs despite negative consequences
such as significant problems in daily living.
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Substance Addiction
Addiction usually refers to a behavioral pattern
of alcohol or drugs abuse characterized by
overwhelming involvement with the use of the drug
and compulsion in obtaining the drug. There is a
high tendency for relapse after discontinuation.
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Substance Withdrawal
Withdrawal occurs when there is a pattern of use
that escalates creating tolerance. When the
abused substance is removed there is a
physical response to the absence of the drug.
Nurses responsibility during drug withdrawal
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Substance- Induced Psychotic Disorders
This disorder is marked by prominent
hallucinations and delusions that are directly
related to substance abuse. Either alcohol
ingestion, use of or misuse of medications and
or exposure to toxins.
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Factors Influencing Substance Abuse
Psychosocial and Behavioral Biological Theoretical

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Substances-Induced Psychosis
Causes Drug Abuse Alcohol Amphetamines Cocaine I
nhalants Opioids
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Substances-Induced Psychosis
Causes Medications Anesthesia Anticholinergics A
nticonvulsant Antidepressant Cardiovascular
Chemotherapy Corticosteriods Muscle
relaxants NSAIDS
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Substances-InducedPsychosis
Causes Toxins Volatile substances-paint or
fuel Insecticides Nerve gas Carbon
Monoxide Carbon Dioxide
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Abuse and Use of Alcohol
Aspects of Genetics Personality Social
learning Cultural
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Alcohol Abuse and Dependence
Alcohol is classified as a food product. Alcohol
is a CNS depressant. It causes behavioral
changes as well as mood changes. These changes
are proportionally related to the amount of
alcohol consumed. Alcohol concentration is
measured by a blood alcohol level.
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Know your Limits
Since 2004 all states are required to have the
same legal definition of alcohol intoxication.
Standard legal level .08 g/dl
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What do you think?
Which patient is going to be the drunkest? The
patient who presents with a history of drinking
all night while at a dinner party.
OR The patient who present with a
history of being angry with their spouse who has
only been drinking for two hours angry?
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Alcohol Abuse
Tolerance develops after prolonged
heavy drinking. Physical tolerance or
tissue adaptation means that cellular changes
occur in the central nervous system. So
that more of the drug is needed by the body
to provide the desired effect.
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Alcohol Abuse
Blackout is an alcohol induced state. It is the
ability to mask behavioral effects of alcohol. A
blackout is different than passing out.
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Alcohol Induced Disorders
Intoxication occurs after drinking excessive
amounts of alcohol and is evidenced
by maladaptive behaviors such as
fighting, impaired judgment and interference
with social and work abilities.
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Alcohol Induced Disorders
Alcoholic hallucinations usually occur 48 hours
after cessation of alcohol.
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Alcohol Induced Disorders
Amnestic disorder results from prolonged heavy
drinking and is thought to be related to poor
nutrition.
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Alcohol Induces Disorders
Alcoholic dementia associated with
chronic prolonged alcoholic dependency. This
is permanent.
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Nursing Process- Alcohol
Assessment Focus is on physical symptoms and
social interactions. If the nurse suspects
alcohol use or abuse. Use the Cage
questionnaire.
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Nursing Process-Alcohol
Diagnosis consider physical as well as
Emotional needs. Focus on priority issues. Many
diagnoses apply and recovery is ongoing and
long-term.
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Nursing Process-Alcohol
Planning The goal is recovery. Recovery occurs
in different stages
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Nursing Process- Alcohol
Implementation Nursing care of the client
experiencing alcohol withdrawal is safety.
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Nursing Process- Alcohol
Evaluation Measurable objective data
which direction the client is heading.
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Treatment for Alcoholism
Recovery Based Therapy. Behavioral
changes. Substituting one behavior for another.
These clients are never really cured.
Pharmacology Counseling Group therapy Family
Support Groups
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Medications for Alcoholic Abuse
Disaffirm (Antabuse) Used for patients who abuse
alcohol. It is a drug that is used for it
deterrent side effects. When a patient taking
disulfiram ingests alcohol the patients body
experiences symptoms that are uncomfortable and
cause violent vomiting.
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Medication for Alcohol Abuse
Benzodiazapines Most widely used group with
alcohol withdrawal. (Librium and
Valium). Anticonvulsants Withdrawal seizures.
Acute and long-term cravings.
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Medications for Alcohol Abuse
Vitamin therapy Thiamine and B12.
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Family Dynamics and Alcoholic Children
Nursing responsibilities Caring for the client
and the family.
Support Groups ALANON ACOA
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Substance Abuse- Controlled Substances
Amphetamines, amphetamine-like drugs such as
methamphetamies, cocaine and inhalants.
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Amphetamine Abuse
Symptoms autonomic instability,
irritability, anxiety, loss of coordination and
loss of muscle control.
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Amphetamine Abuse
Overdose Agitation, hallucinations and
convulsions. DEATH.
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Amphetamine- Abuse
Withdrawal
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Substance Abuse- Narcotics
Intentional ingestion of narcotic substances. The
use and misuse of Heroin, Morphine, Opium or
other substances. Opioid intoxication is
treated with a narcotic antagonists.
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Medications for Narcotic Abuse
Naloxone (Narcan) Competitive antagonism.
Displaces previous narcotics Naltrextone
hydrochloride (Nalorex, ReVia) Blocks the effects
of opioids. Attaches to Opioid receptor sites.
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Therapeutics- Narcotics
Withdrawal treatment Sedatives hypnotics to
relieve anxiety. Barbiturates and tranquilizers.
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Narcotic Withdrawal
6-12 hours. Symptoms Treatment sever
cramping, Tremors, panic and chills. Medical
management is often required with narcotic
withdrawal.
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Personality Disorders
Personality disorder is a collection of
personality traits that have become fixed and
rigid. Personality disorders are considered
serious psychiatric conditions because of their
associated symptoms.
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Cause of Personality Disorders
The actual cause of personality disorders is
unknown. Other factors contributing to
personality disorders are thought to be
psychosocial in nature.
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Personality Disorders
In order for a personality disorder to occur. It
has to be void of any other explanation. It has
to exist alone. ...In most cases a personality
disorder is not recognized until the patients
seeks treatment for a substance abuse related
problem.
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Personality Clusters
Cluster A paranoid, schizoid and schizotypal
disorders represents people with odd and
eccentric behavior. Cluster B antisocial,
boderline, historionic, And naracissistic
personality disorders. These People appear
dramatic, emotional and erratic.
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Personality Clusters
Cluster C avoidant, dependant and Obsessive-
compulsive personality types represent people
with anxiety and fear issues.
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Types of Personality Disorders
Paranoid Personality Disorder Antisocial
Personality Disorder Borderline Personality
Disorder Histrionic Personality
Disorder Narcissistic Personality Disorder
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Types of Personality Disorders
Avoidant Personality Disorder Dependent
Personality Disorder Obsessive-Compulsive
Disorder Passive-Aggressive Disorder
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Behavioral traits of Personality Disorders
Chronic depression Inability to be
alone Clinging Splitting Manipulation Self-
destruction
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Nursing ProcessPersonality Disorders
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Treatment of personality Disorders
Treatment is difficult because these people often
do not seek treatment for their
actual personality issues. Meaning it is
discovered that a client has a maladaptive
personality during the course of treatment for
another problem.
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Implications and Prognosis
Worsening symptoms Improvement of symptoms over
time Treatment drop-out Treatment refusal
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Treatment of Personality Disorders
Long-term restructuring of personality.
Psychotherapy. Treatment focuses on immediate
problem-solving skills, enhancement of coping
skills and improvement of social skills.
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Pharmacology Personality Disorders
Antipsychotics Antidepressants Lithium
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Therapies
Alcohol Anonymous Self-help through the support
of others. Sobriety is goal. Narcotics
Anonymous 12 step program Counseling The
relationship is goal-directed. Counseling may
last months to years.
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Therapies
Group therapy A powerful agent of change. The
patient see themselves in others in the group.
They are confronting their own fears r/g giving
up the substance. These groups focus on open
communication and sticking to a task-oriented
goal.
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Therapies
Interpersonal therapy Used with personality
disorders. It can be used to help patients
understand and modify maladjusted behaviors,
cognition and affects. The core of this therapy
is the role of the empathetic therapist- client
relationship.
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Therapies
Psychoanalytical therapy Treatment of choice for
patients w/ histrionic personality disorder.
Treatment focuses on unconscious motivation
for seeking total satisfaction from other and
for being unable to commit oneself to a stable
meaningful relationship.
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Therapies
Cognitive/Behavioral therapy Offers positive
reinforcement for change. Social-skill training,
teaching alternative ways To deal w/ frustration.
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Nursing Process
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Therapies
Family Therapy Is beneficial to decrease Over
involvement and fusion. Focus of therapy is
reducing over involvement, acting out and
inappropriate dependence.
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Nursing Issues Associated with Mental Health
Concepts
Problems solving Goal identification and
evaluation Modification to plan of care Self-care
issues